Tumor budding in intestinal-type gastric adenocarcinoma is associated with nodal metastasis and recurrence

Stephen Olsen, Linda Jin, Ryan C. Fields, Yan Yan, ILKe Nalbantoglu

Research output: Contribution to journalArticlepeer-review

33 Scopus citations


Gastric adenocarcinoma (GAC) is a common cause of cancer-related death worldwide. GAC can be classified as intestinal or diffuse. Intestinal-type cancers are common and reported to have a better prognosis compared to diffuse cancers. Studies have shown the presence and amount of tumor budding in intestinal carcinomas of the colon and esophagus to predict nodal metastasis and recurrence. Our aim is to determine if tumor budding in intestinal-type GAC correlates with prognostic features. One hundred four patients treated with primary surgical excision between 1999 and 2013 were identified. Histologic type (intestinal, diffuse, or mixed), tumor grade, T-stage, and lymph node status were evaluated. Tumor bud scores were assigned to all intestinal-type cancers using methods previously described for colorectal adenocarcinoma. Scores of <1 were designated as low and ≥1 as high. Tumor characteristics were as follows: 52 intestinal (50%), 36 diffuse (35%), and 16 mixed (15%). Of the 52 cases with intestinal histology, 4 were well (8%), 28 were moderately (54%), and 20 were poorly differentiated (38%). Thirty-three (63%) of the intestinal tumors had high tumor bud scores. Cases with high scores were associated with higher T-stage, N-stage, and grade (P <.001, P <.001, and P =.002). These also had a higher likelihood of recurrence (P =.007). In our cohort, high tumor bud scores in intestinal-type GAC have higher T-stage, N-stage, grade, and likelihood of recurrence. Assessment of tumor budding may guide clinical management in a subset of patients.

Original languageEnglish
Pages (from-to)26-33
Number of pages8
JournalHuman Pathology
StatePublished - Oct 2017


  • Adenocarcinoma
  • Gastric adenocarcinoma
  • Node metastasis
  • Recurrence
  • Tumor budding


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